Download Chartpack - American Hospital Association

Hospitals Demonstrate Commitment
to Quality Improvement
October 2012
Research and analysis by
Avalere Health
Quality improvement can be viewed as a five-step
process.
Chart 1: Five Steps to Improving Quality
Identify Target Areas
for Improvement
Disseminate Results
to Spur Broad Quality
Improvement
Track Performance
and Outcomes
Determine What
Processes Can Be
Modified to Improve
Outcomes
Develop and Execute
Effective Strategies to
Improve Quality
Source: Analysis by Avalere Health and American Hospital Association.
Research and analysis by Avalere Health
Hospitals engage with government agencies and
non-governmental bodies on quality improvement.
Chart 2: Sample of Hospital Quality Improvement Partners and Entities
Centers for
Medicare &
Medicaid
Services
Agency for
Healthcare
Research and
Quality
Centers for
Disease
Control and
Prevention
The Joint
Commission
National
Quality
Forum
Disease Groups
(e.g., American
Heart
Association)
Private Payers
Professional
Societies
Health
Resources
and Services
Administration
Quality
Improvement
Initiatives
Institute for
Healthcare
Improvement
Department of
Veterans Affairs
Department
of Health
and Human
Services
Partnership for
Patients
States
Regional
Collaboratives
Public Health
Agencies
Health Research
and Educational
Trust
Source: Analysis by Avalere Health and American Hospital Association.
Research and analysis by Avalere Health
Premier/
VHA/
Group
Purchasing
Organizations
National quality campaigns have improved hospital
delivery of cardiac care.
Chart 3: Percentage of Patients Undergoing Percutaneous Coronary Interventions
within 90 Minutes of Arrival at a Hospital, 2007 – 2011
87%
91%
94%
Percentage of Patients
82%
72%
2007
2008
2009
2010
2011
Source: The Joint Commission. Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality
and Safety 2012.
Research and analysis by Avalere Health
Evidence-based protocols have improved quality in
intensive care units (ICUs).
CLABSIs per 1,000 Central Line Days
Chart 4: CLABSIs per 1,000 Central Line Days at Hospitals Participating in Michigan
Hospital Association (MHA) Keystone: ICU, 2004 – 2009
2.50
1.39
1.18
1.17
0.98
2004
2005
2006
2007
2008
0.86
2009
Source: MHA Keystone Center for Patient Safety & Quality. 2010 Annual Report.
Research and analysis by Avalere Health
Hospitals have progressed in combating hospitalacquired infections…
Chart 5: Central Line-associated Bloodstream Infection (CLABSI) Standardized
Infection Ratio (SIR), 2006 – 2010
Standardized Infection Ratio
1.2
1.0
0.8
0.6
0.4
0.2
0.0
2006-2008 (base)
2009
2010
Source: U.S. Department of Health and Human Services. Health System Measurement Project. Central LineAssociated Bloodstream Infection Standardized Infection Ratio.
Note: SIR is a ratio of the observed number of CLABSI as reported to CDC's National Healthcare Safety Network
(NHSN) each year to the predicted occurrence based on the rates of infections among all facilities reporting to
NHSN during the referent period (January 2006 through December 2008). SIR below 1.0 means hospitals
reported fewer infections than predicted.
Research and analysis by Avalere Health
…and in adhering to accepted treatment protocols.
Chart 6: Adult Surgery Patients Who Received Appropriate Timing of Antibiotics, by
Age, 2005 – 2009
100%
Percent of Patients
95%
90%
85%
Under 65
80%
65-74
75%
75-84
70%
85 and
Over
65%
60%
2005
2006
2007
2008
2009
Source: U.S. Department of Health and Human Services. (2011). National Healthcare Quality Report.
Washington, DC: Agency for Healthcare Research and Quality.
Research and analysis by Avalere Health
Hospital efforts to curb infections have produced
impressive results.
Chart 7: Percentage of On the CUSP: Stop BSI Intensive Care Units (ICUs) with Zero
Percent Central Line-associated Bloodstream Infection (CLABSI) Rate
80%
Percent of Units (N=660)
70%
Intervention
60%
50%
40%
30%
20%
12 Months Before
Intervention
1-3 Months Post
Intervention
4-6 Months Post
Intervention
7-9 Months Post
Intervention
10-12 Months Post
Intervention
Source: Agency for Healthcare Research and Quality. CLABSI Update.
http://www.ahrq.gov/qual/clabsiupdate/clabsiupdate.pdf.
Note: To achieve a zero percent CLABSI rate, an ICU had to report no CLABSIs for each data point submitted
during the period.
Research and analysis by Avalere Health
Collaboration to develop and implement multiple
interventions across a system can yield quality
gains.
Chart 8: Unadjusted Mortality Decline and Case-mix Index in Hospitals in the
Ascension Health System, 2004 – 2010
Deaths per 100 Discharges
Case-mix Index
1.49
2.2
1.47
2
1.45
1.8
1.43
1.6
1.41
1.4
1.39
1.2
1.37
1
1.35
2004
2005
2006
2007
2008
2009
2010
Source: Pryor, D., et al. (April 2011). The Quality ‘Journey’ At Ascension Health: How We’ve Prevented At Least
1,500 Avoidable Deaths A Year—And Aim To Do Even Better. Health Affairs, 30(4): 604-611.
Research and analysis by Avalere Health
Case-mix Index
Deaths per 100 Discharges
2.4
Broad dissemination of quality improvement
successes can improve outcomes across a hospital
system.
Chart 9: System-wide Infection Counts at Legacy Health, 2008 and 2010
90
Deaths per 100 Discharges
80
70
Baseline
Performance
(March 2008)
60
50
Performance at
End of Study
(March 2010)
40
30
20
10
0
Catheter-associated
Urinary Tract Infection
Surgical-site Infection
Total Infections
Source: Joyce, J., et al. (2011). Legacy Health's 'Big Aims' Initiative To Improve Patient Safety Reduced Rates Of
Infection And Mortality Among Patients. Health Affairs, 30(4): 619-627.
Research and analysis by Avalere Health
More hospitals are adhering to accepted surgery
care guidelines.
Chart 10: Rate of Adherence to Surgical Care Improvement Project (SCIP) Process
Measures, Fiscal Years (FY) 2008 and 2009
100%
98%
Rate of Adherence
96%
94%
92%
90%
FY 2008
88%
FY 2009
86%
84%
82%
80%
Antibiotics within 1 Received prophylactic Prophylactic antibiotics
Controlled 6 am
hour before incision or antibiotics consistent discontinued within 24 postoperative serum
within 2 hours if
with recommendations hours of surgery end
glucose for cardiac
vancomycin or
time or 48 hours for
surgery patients
quinolone is used
cardiac surgery
Appropriate hair
removal for surgery
patients
Source: Centers for Medicare and Medicaid Services. Progress Toward Eliminating Healthcare-Associated
Infections – September 23-24, 2010. http://www.hhs.gov/ash/initiatives/hai/actionplan/cms_scip.pdf.
Research and analysis by Avalere Health
Hospitals are advancing on evidence-based quality
measures.
Chart 11: Percentage of Hospitals Achieving Composite Rates Greater Than 90
Percent for Accountability Measures, 2007 and 2011
100%
Percentage of Hospitals
90%
80%
70%
2007
60%
2011
50%
40%
30%
20%
10%
0%
Heart Attack
Pneumonia
Surgical Care
Children's Asthma
Source: The Joint Commission. Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality
and Safety 2012.
Research and analysis by Avalere Health
Hospitals’ quality initiatives are yielding better
patient outcomes.
Deaths per 1,000 Admissions
Chart 12: Inpatient Deaths per 1,000 Adult Hospital Admissions with Heart Attack, by
Age, 2000 – 2008
160
140
120
100
80
65 and over
60
Total
40
45-64
20
18-44
0
2000
2004
2005
2007
2008
Source: U.S. Department of Health and Human Services. (2011). National Healthcare Quality Report.
Washington, DC: Agency for Healthcare Research and Quality.
Research and analysis by Avalere Health